Suction posterior capsulorhexis: an audit of 15†years' experience.

AIMS: To audit the results of 15 years' experience of suction posterior capsulorhexis (SPC) during phacoemulsification and compare the outcomes with a recently published multicentre audit of cataract surgery, the Cataract National Dataset (CND). METHODS: Prospective cohort observational study. SETTING: Ophthalmology department of a district general hospital. RESULTS: Data collection ran from June 1998 to November 2013, and 866 eyes of 786 patients were included. The mean (SD) age was 70.7 (12.4) years with 62% women. Low levels of perioperative and postoperative complications were noted, and the visual outcomes at 2 weeks in this audit were significantly better than those of the CND, with 75.4% achieving a best-corrected vision of ≥6/6 and 87.3% ≥6/12, improving to 95.8% and 100%, respectively, for best-case analysis (p<0.001 for all comparisons). 99% achieved the same or a better postoperative visual acuity than preoperatively compared with 95% in the CND (p<0.001) and none lost two lines of Snellen acuity (versus 1.24%; p<0.001). Patients receiving one of the two designs of square-edged hydrophobic acrylic intraocular lenses used in this audit did not require later YAG laser treatment compared with 2.72% of those who had a polymethylmethacrylate intraocular lens (p<0.02). Biometry accuracy was within ±1.0 D of the predicted refraction in 89.3%. CONCLUSIONS: SPC, when performed by an experienced surgeon, appears to achieve better visual outcomes than the CND without causing harm to patients nor adversely affecting biometry accuracy. Use of a hydrophobic acrylic intraocular lens with SPC may avoid the need for subsequent YAG laser therapy.

A rapidly growing lid lump.

A 97-year-old woman presented with a 5-month history of a rapidly growing, painless, left upper eyelid lesion. Examination revealed a large vascularised, ulcerated nodule on the left upper lid, causing significant ptosis. Wide local excision of the lesion was performed and the wound was left to heal by secondary intention. Histology and immunohistochemistry of the lesion confirmed a diagnosis of Merkel cell carcinoma, a rare primary malignancy of the eyelid which has significant morbidity and mortality. Although uncommon, this diagnosis should always be considered in any patient with a rapidly growing lid lump. In view of the patient's age, known dementia and family wishes, the patient was managed conservatively, with no further investigations performed. She was due to be followed up in clinic on a regular basis, but has since died from other causes.

Consecutive toxic anterior segment syndrome in combined phaco-vitrectomy.

Toxic anterior segment syndrome (TASS), though rare, has been well documented following anterior segment surgery but not following vitrectomy (Monson et al., J Cataract Refract Surg 18:184-189, 1992). It typically presents within 24 h of uncomplicated cataract surgery with minimal or no pain and intense anterior segment inflammation (Monson et al. 1992). Various exogenous chemicals have been identified as the cause of TASS (Kutty et al., Cataract Refract Surg, 34:585-590 2008; Liu et al., J Cataract Refract Surg 27:1746-1750, 2001).

Standing phacoemulsification: a prospective audit of 20 consecutive cases.

PURPOSE: To audit the surgical and postoperative complications and the visual outcomes of standing phacoemulsification and compare these with the results of conventional seated phacoemulsification. SETTING: District general hospital, Sidcup, England. DESIGN: Prospective comparative case series. METHODS: This prospective audit comprised consecutive patients having standing phacoemulsification; a control group was drawn from all conventional phacoemulsification procedures on the same operating lists. One eye per patient was included. Demographic and surgical data, complications, and preoperative and postoperative visual acuity and intraocular pressure were recorded. Paired and unpaired t tests were used to compare mean values, and the chi-square test with Yates correction or the Fisher exact test was used to compare frequencies. RESULTS: Twenty patients requiring standing phacoemulsification and 89 control patients were enrolled over a 32-month period. The 2 groups were similar in characteristics except the standing group was younger (68.2 years versus 78.0 years) (P<.005) and had a longer axial length (23.8 mm versus 23.1 mm) (P<.05). No patient in the standing group and 6% of patients in the control group had operative complications, although the difference between groups was not statistically significant. The rates of postoperative complications were comparable. Pinhole-corrected distance visual acuity was similar (6/12 or better: 90% in standing group and 94% in control group; 6/6 or better: 55% and 44%, respectively). Best-case analyses were similar between groups (6/12 or better, 100% versus 98%; 6/6 or better, 58% versus 51%). CONCLUSIONS: Standing phacoemulsification was as safe as conventional seated surgery when performed by the same experienced surgeon. Visual results were excellent.

A spontaneous suprachoroidal haemorrhage: a case report.

INTRODUCTION: We present a case of spontaneous suprachoroidal haemorrhage in a patient taking Warfarin. This is only the second case reported of a patient whose anticoagulation was within the therapeutic range. CASE PRESENTATION: An 84 year old white male with a history of end stage atrophic age related macular degeneration presented with angle closure glaucoma. The patient was taking warfarin and had a therapeutic International Normalized Ratio (INR). Ultrasound examination revealed a spontaneous suprachoroidal haemorrhage. CONCLUSION: Anticoagulation is common in those with cardiovascular disease, which increases the risk of haemorrhagic complications. These patients are also more likely to suffer from age related macular degeneration. Suprachoroidal haemorrhage should be considered in such patients presenting with suspicious signs and a low threshold should be had for investigating for this condition in such circumstances. Early detection may reduce the morbidity.

Diplopia associated with the cosmetic use of botulinum toxin a for facial rejuvenation.

We report three cases in which cosmetic injections of botulinum toxin A around the eye caused diplopia. Diplopia was due to inferior oblique paresis, which was bilateral in two cases. We suggest that consent for periocular botulinum toxin procedures should include a warning about diplopia.

YAG curios #1: repeat Nd:YAG laser posterior capsulotomy.

A descriptive case series of five patients identified either opportunistically or from a retrospective review of the laser register is presented. All underwent cataract surgery between 1995 and 1999 and required initial Nd:YAG laser posterior capsulotomy 15-30 months after surgery. They subsequently developed reclosure of the capsulotomy, necessitating repeat laser capsulotomy 11-82 months later. One patient, who received a hydrogel intraocular lens, required a third capsulotomy after a further 12 months. The rate of repeat Nd:YAG laser capsulotomy in our unit was 0.31%.

YAG curios #2: Nd:YAG laser treatment following suction posterior capsulorhexis.

Suction posterior capsulorhexis (SPC) is a relatively new technique for creating a posterior capsulorhexis. We present a case series of seven patients who required Nd:YAG laser treatment 27 months after SPC. No patient had pre-existing risk factors for increased postoperative inflammation and all received a one-piece polymethylmethacrylate intraocular lens placed in-the-bag. Although it reduces the need for Nd:YAG laser treatment, SPC, like the more usual forceps posterior capsulorhexis, does not completely eliminate it.

Effect of pupil dilation on the accuracy of the IOLMaster.

PURPOSE: To evaluate the effect of pupil dilation on the accuracy of the IOLMaster (Zeiss) in performing biometry and to assess test-retest variability without pupil dilation. SETTING: Ophthalmic outpatient department of a district general hospital. METHODS: This prospective study comprised consecutive patients presenting to a cataract clinic (study group) who had biometry performed with the IOLMaster before and after pupil dilation. A control group was recruited from consecutive patients attending a cataract preassessment clinic who had 2 sets of biometric measurements with the IOLMaster but without pupil dilation. The SRK/T formula was used to calculate intraocular lens (IOL) power. RESULTS: The IOLMaster showed excellent reproducibility in the control group with no significant test-retest variability between the 2 sets of readings. The study group showed a statistically significant change in K2 and average keratometry values (P <.05) but no significant change in axial length or IOL power between undilated and dilated pupil biometry readings. No systematic errors were revealed. CONCLUSIONS: Dilating the pupil did not adversely affect the clinical accuracy of the IOLMaster.

Intraoperative and early postoperative results of suction posterior capsulorhexis.

PURPOSE: To report the intraoperative complications and early postoperative visual results of suction posterior capsulorhexis (SPC). SETTING: Ophthalmology department of a district general hospital, Kent, United Kingdom. METHODS: This prospective observational study included all patients having phacoemulsification who required SPC as a planned procedure or because of posterior capsule tears (128 eyes of 122 patients). All patients were under the care of a single consultant. Intraoperative complications related to the SPC as well as postoperative complications and best corrected visual acuity (BCVA) in all cases and with best-case analysis (patients with preexisting ocular comorbidity excluded) were noted. RESULTS: Seven cases (5.5%) of vitreous prolapse occurred; none was specifically related to the SPC. A BCVA of 0.67 (6/9) or better was achieved in 94% of cases (100% of best cases). One retinal detachment (0.8%) occurred 8 months postoperatively that was successfully treated with no loss of BCVA. CONCLUSION: Suction posterior capsulorhexis had a low rate of intraoperative complications and did not adversely affect the early visual outcome.